Product Description

Please note: This document provides a high-level overview of our plans and benefits. For full benefit information, please refer to the 2017 Product Brochure. Where there is a discrepancy between the content provided in this document, the brochure, the website and the Scheme Rules, the Scheme Rules prevail. The Scheme Rules are available on request. Benefits are subject to approval from the Council for Medical Schemes.

Additional Information

HOSPITAL NETWORK

Yes. Members have access to all private hospitals. A 30% co-payment will apply to admissions at specific hospitals.

Unlimited, covered at 100% of the Bonitas Rate
Your therapist must get a referral from the doctor treating you in hospital
[]

INTERNAL AND EXTERNAL PROSTHESES

Internal prosthesis
R49 600 per family

External prosthesis
R49 600 per family

Pre-authorisation required

INTERNAL NERVE STIMULATORS

R149 100 per family
Pre-authorisation required
[]
[]

COCHLEAR IMPLANTS

R250 000 per family
You must use a preferred supplier
[]
[]

MENTAL HEALTH HOSPITALISATION AND CONSULTATIONS

Hospitalisation
R42 200 per family
No cover for physiotherapy for mental health admissions
You must use a Designated Service Provider

Consultations (in and out of hospital)
R14 300 per family
In and out of hospital for consultations (included in the mental health hospitalisation benefit)
No cover for educational psychologists for beneficiaries older than 21 years

TAKE-HOME MEDICINE

R 490 per beneficiary, per hospital stay
[]

PHYSICAL REHABILITATION

R44 650 per family
Pre-authorisation required
[]

ALTERNATIVES TO HOSPITAL (HOSPICE, STEP-DOWN FACILITIES)

R14 900 per family
Pre-authorisation required
[]
[]
[]

CANCER TREATMENT

R556 700 per family
R220 900 of this can be used for specialised drugs (including biological drugs)
Pre-authorisation required

NON-CANCER SPECIALISED DRUGS

R176 700 per family

Managed Care protocols apply
Pre-authorisation required
[]
[]

ORGAN TRANSPLANTS

Unlimited
Pre-authorisation required

KIDNEY DIALYSIS

Unlimited, at a preferred provider
Pre-authorisation required

HIV/AIDS

Unlimited, if you register on the HIV/AIDS programme

C

OUT-OF-HOSPITAL

GP CONSULTATIONS

Paid from available savings and/or above threshold benefit
[]

SPECIALIST CONSULTATIONS

Paid from available savings and/or above threshold benefit
You must get a referral from your GP
[]

Cover for 62 chronic conditions
R12 450 per beneficiary
R24 800 per family
Applicable formulary applies, 40% co-payment for out of formulary medicine
Once the amount above is finished, you will still be covered for the 27 PMB conditions
Pre-authorisation required

D

SUPLEMENTARY-BENEFITS

INTERNATIONAL TRAVEL BENEFIT

R5 million per beneficiary per journey for both in and out of hospital treatment (R10 million per family)

MATERNITY CARE PER PREGNANCY

Private ward after delivery
12 antenatal consultations with a gynaecologist, GP or midwife 2 2D ultrasound scans
R1 100 for antenatal classes
1 amniocentesis
4 consultations with a midwife after delivery
A Bonitas baby bag (you must register for this after obtaining pre-authorisation for the delivery)